CASE REPORTSubdural hematoma after an epidural blood patch
Introduction
The incidence of postdural puncture headache (PDPH) after spinal anesthesia using pencil-point needles ranges from 0.66% to 4% in patients undergoing elective caesarean delivery.1, 2 An epidural blood patch (EBP), first described by Gormley in 1960,3 is the most effective treatment with a reported cure rate of 33–66% after one blood patch.4, 5, 6 EBP is a low-risk procedure. Reported complications include arachnoiditis, back pain, and infection. We report the case of a 37-year-old woman who developed excruciating bilateral buttock and lateral thigh pain after an EBP. A magnetic resonance imagining (MRI) scan demonstrated a contained subacute spinal subdural hematoma (SDH) causing mass effect on the cauda equina and severe spinal stenosis. To our knowledge, this is the first case report of a spinal SDH in a postpartum patient as a complication of an EBP performed for PDPH from a pencil-point spinal needle.
Section snippets
Case report
A healthy 37-year-old G3P2 woman with an uncomplicated pregnancy at 38 weeks of gestation presented with premature rupture of membranes and was admitted for oxytocin augmentation of labor. She had an uncomplicated vaginal delivery without neuraxial analgesia and underwent postpartum tubal ligation (PPTL) under spinal anesthesia 12 h after delivery. Spinal anesthesia was uneventful: a single needle insertion was performed at L3–4 in the sitting position using a Pencan™ 25-gauge needle (B. Braun,
Discussion
The most common complaint after EBP is of low back pain,7 but rare adverse events include cauda equina syndrome,8, 9 hematoma,9, 10, 11 pneumocephalus,12, 13 and arachnoiditis.14 Riley and Spiegel described an obstetric patient who developed lumbosacral radiculopathy after high-volume (58 mL blood) EBP for PDPH following accidental dural puncture.15 MRI demonstrated a small spinal subdural hematoma spanning T12–L4, with mild displacement of nerve roots and a mass effect on the conus medullaris.
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Cited by (21)
Risk factors for recurrence of post-dural puncture headache following an epidural blood patch: a retrospective cohort study
2023, International Journal of Obstetric AnesthesiaEpidural blood patch: A narrative review
2022, Anaesthesia Critical Care and Pain MedicineTreatment of obstetric post-dural puncture headache. Part 2: epidural blood patch
2019, International Journal of Obstetric AnesthesiaCitation Excerpt :Space-occupying lesions in the spinal canal have the potential to produce both ischaemic and inflammatory damage to nerve tissue. A number of obstetric cases of spinal-subdural haematoma43,47,48 and intrathecal haematoma45,46,49,50 associated with the performance of an EBP have been reported, and non-obstetric cases have been described.51–57 In addition to arachnoiditis, Riley and Speigel reported a spinal-subdural haematoma following a 58 mL EBP.44
A complication of an epidural blood patch
2016, Journal of Clinical NeuroscienceIntrathecal haematoma: A rare cause of back pain following epidural blood patch
2015, International Journal of Obstetric AnesthesiaChanging the needle for lumbar punctures: Results from a prospective study
2015, Clinical Neurology and NeurosurgeryCitation Excerpt :In a literature review, Zeidan et al. [6] discovered 46 cases of unilateral or bilateral intracranial subdural hematomas following spinal and epidural anesthesia, of which at least six were mortal. Furthermore, spinal hematomas [7], post-partum seizures [2], coma [8], and cranial nerve palsies [9] have been attributed to dural puncture and PDPH. The incidence of PDPH varies between <1% and 70%, and is dependent on both patient and procedural characteristics [10].